Effect of addition of Ondansetron or Magnesium to Lidocaine on duration of analgesia of intravenous regional anesthesia in elective upper extremities surgery: comparative study.

BackgroundThis study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity.Settings and design The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine + 4 mg/kg ondansetron, and group M lidocaine + 7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests.ResultsThe time for onset of sensory and motor blocks in group M was significantly shorter than the groups C and O (P <0.05). In terms of the recovery time of sensory block, the time of group O was significantly longer than those of groups M and C (P <0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than those of group C (P< 0.05). No significant difference was observed in postoperative pain and other features among the groups (P >0.05).ConclusionMagnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required.BackgroundThis study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity.Settings and design The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine + 4 mg/kg ondansetron, and group M lidocaine + 7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests.ResultsThe time for onset of sensory and motor blocks in group M was significantly shorter than the groups C and O (P <0.05). In terms of the recovery time of sensory block, the time of group O was significantly longer than those of groups M and C (P <0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than those of group C (P< 0.05). No significant difference was observed in postoperative pain and other features among the groups (P >0.05).ConclusionMagnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required

Effect of addition of ondansetron or magnesium to lidocaine on duration of analgesia of intravenous regional anesthesia in elective upper extremities surgery: Comparative study

Background: This study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity. Methods and Materials: The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine +4 mg/kg ondansetron, and group M lidocaine +7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests. Results: The time for onset of sensory and motor blocks in the M group was significantly shorter than the groups C and O (p<0.05). In terms of the recovery time of the sensory block, the time of group O was significantly longer than those of groups M and C (p<0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than of group C (p<0.05). No significant difference was observed in postoperative pain and other features among the groups (p>0.05). Conclusion: Magnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required. Keywords: Bier Block, Ondansetron, Magnesium, Lidocain

Comparison of preemptive effect of intravenous ketorolac versus meperidine on postoperative shivering and pain in patients undergoing cesarean section under spinal anesthesia: A prospective, randomized, double-blind study

Background: Pain and shivering are two unpleasant problems in postoperative period. Various techniques are used to alleviate the postoperative shivering and pain. We compared the preemptive prescription of a single dose of intravenous meperidine and ketorolac on postoperative pain and shivering in patients undergoing cesarean section with spinal anesthesia. Methods: One hundred and fifty patients who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ketorolac (group K), meperidine (group M) or normal saline (group P). Time to first analgesic request, analgesic requirement in the first 24 hours after surgery, body tympanic temperature, hemodynamic variables and incidence of shivering were assessed as outcome variables. Results: There was no significant difference between meperidine and ketorolac groups in terms of prevalence of shivering, although both groups were different from the placebo group (p<0.04). The mean time to first analgesic request was longer in group k (3.8±1.4) and groups M (3.3±1.2) than in group P (2.1±0.8) hours (p<0.001). Conclusions: The preemptive prescription of a single dose of intravenous meperidine and ketorolac can provide a satisfying analgesia immediately after surgery and decrease shivering prevalence without any serious side effects

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill &amp; Melinda Gates Foundation

Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1.49 million deaths (95% uncertainty interval 1.39-1.59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1.3% in males and 1.6% in females, almost half that of males aged 1-4 years (2.4%), and around a third less than in females aged 1-4 years (2.5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9.5% to 21.6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Clinicopathological Findings of the Cardia and Gastroesophageal Junction in Adult Candidates for Endoscopy in Qazvin, Iran

Background: Chronic inflammation and intestinal metaplasia lead to gastric and esophageal adenocarcinoma. Past research has provided controversial findings about the etiology of inflammation and intestinal metaplasia in the cardia and the Z-line. Objectives: The aim of this study was to evaluate clinicopathological findings of the cardia and gastroesophageal junction in adult candidates for endoscopy in Qazvin, Iran. Methods: Biopsy was performed for 124 ambulatory adult patients without any evidence of cancer. Specimens were obtained from the antrum and the cardia of the stomach, the Z-line, and 2 cm above the Z-line. A comparison was made between the histological, clinical and endoscopic data obtained from the patients. Results: Helicobacter pylori were significantly related to active inflammation in the antrum and the cardia, but not in the Z-line. Another finding was that active carditis was related to active antritis and active Z-line inflammation. A further observation was the positive correlation between cardiac and Z-line metaplasia. Finally, a relationship was observed between the type of cardiac mucosa and the presence of metaplasia in the cardia and the Z-line. Conclusions: The study revealed thatinflammationin the cardia and, to a lesser extent, the Z-line is related to H. pyloriandantral gastritis and that the metaplasia of these areas is related to gastroesophageal reflux disease. Lastly, both H. pylori and gastroesophageal reflux disease are important in the pathology of these areas. Keywords: Cardia, Z-Line, Gastroesophageal Reflux Disease, Histopathology, Helicobacter pylor

Clinicopathological Features of Colon Adenocarcinoma in Qazvin, Iran: A 16 Year Study

Abstract Background: Colorectal cancer (CRC) was the fourth most commonly diagnosed cancer in Iran between 2000 and 2009, with adenocarcinoma (AC) as the most common histological type. Demographic, topographic and histological variables are important in the epidemiology and biology of cancer. The aim of this study was to investigate clinicopathological features of colon adenocarcinomas in Qazvin, Iran. Materials and Methods: With a retrospective design, patient records of two pathology wards from March 1997 to March 2013 were studied with regard to anatomical location and histological classification. A broader anatomical grouping was also used including distal vs proximal regions and right sided vs left sided tumors. Data were analyzed using T-test and chi-square test. Results: 118 (50.9%) male and 114 (49.1%) female patients were included in the study. Mean age was 57.3±14.7 years, with 29.2% under 50 years. There was no significant gender difference for age at diagnosis. The rectum (56%) and sigmoid colon (25%) were the most frequent anatomical locations. Proximal cases accounted for 18.6% in males and 8.8% in females (p=0.02). AC was more prevalent than other usual types in younger patients. The proportion of proximal cancer was 1.7% in first eight years of the study period vs 12.1% in the second one (p=0.005). A similar trend was also seen in right sided colon cancers (p=0.018). Conclusions: Young people are also at risk for the cancer with poor prognosis. Screening programs and weight loss in obese individuals can reduce incidence and complications of CRC. Keywords: Colorectal cancer - adenocarcinoma - colonscopy - anatomical locatio

Epidemiological and Clinicopathological Characteristics of Lung Cancer in a Teaching Hospital in Iran

Background: Lung cancer is one of the most commonly diagnosed cancers and the most frequent cause of cancer-related death worldwide. In Iran, it ranks second and third as the cancer-causing death in men and women, respectively. We carried out this study to find out the demographic, clinical, and histological characteristics and risk factors of lung cancer in a referral tertiary center in Iran. Materials and Methods: A retrospective study was conducted on cases of primary lung cancer based on the results of registered cancer reports of cytological and pathological specimens between March 2001 and March 2012. Demographic variables, clinical manifestations, histology and location of tumors were determined based on the data found in the medical records of each patient. Definite or probable etiologic factors were identified. Data analysis was performed with SPSS version 16 and a p-value ≤0.05 was considered as significant. Results: A total of 203 patients, with a mean age of 65.7 years (SD=11.2), with primary lung cancer were identified, 81.3% being men. Of the total, 110 cases (54.2%) were living in urban areas. In 53.2% of cases, the site of tumor was on the right side and in 72.9% of cases the lesion was centrally located. The histological types of lung cancer were squamous cell carcinoma (SCC) in 107 cases (52.7%), adenocarcinoma (AC) in 30 cases (14.8%), and small cell carcinoma (SC) in 27 cases (13.3%). Significant correlations between the gender and residence, smoking, and the histological type and location (central or peripheral) of tumor were found. The percentage of smokers was 75.2% in men and 15.8% in women. Conclusions: Smoking was the most important risk factor and squamous cell carcinoma the most common histological type of lung cancer in our study. Male sex and being a smoker was associated with histological types of SCC while being nonsmoker had relationship with adenocarcinoma. Keywords: Lung cancer - epidemiology - histological type - risk facto

Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding: Bill & Melinda Gates Foundation